Clinical Care Pathways (CCCP): Magic or Maze?

1. Clinical Care Pathways (CCCP): Magic or Maze? Norah Bostock Operations Manager: Governance

2. CCCP’s-Magic or Maze?

3. The literature reveals CCCP’s as: Powerful clinical tools: proven across the world to organise & provide EB care Providing effective predictable trajectories of care with clinical outcomes Ensuring the 8 rights Facilitators of clinical indicator data Providers of: - Formal care guide supporting decision making - Mechanisms to co-ordinate client & healthcare provider resources - Legal record with minimal documentation - Basis for continuous improvement Pathways: What does the literature say?

4. Pathways: What does the literature say? • Capture and support data on the care journey by being time specific • Include client education and discharge planning • Identified clinical tests are attended • Designed to collaboratively involve both staff and client in the care journey

5. Clinical Pathways: The right person in the right place with the right outcome

6. Pathway applications: Is every clinical situation appropriate for a CCCP? Considered beneficial in the following areas: • High cost e.g. non-healing venous leg ulcers • High risk e.g. medication management • High volume e.g. catheter management • High interest e.g. diabetes/post-acute care Considered suitable for a high % of the population

7. Pathway solutions: Working together across the spectrum

8. Pathway solutions: What does the evidence say? Client outcomes underpinned by best practice leading to: • Consistent pathway implementation and reduced clinical practice variation • Reduced length of stay to deliver outcomes • Returning clients to self management as soon as practicable • Support hospital avoidance by being the “hospital in the home” • Reliable multi-disciplinary collaborative partnership with other care professionals delivering shared care

9. Pathway solutions: What does the evidence say? Staff able to access best practice framework: • Consistent referrer, nurse, client and carer education • Delivers on evidence from National and International benchmarks • Staff can express confidence in the care they deliver even in areas where knowledge is limited • Pathways provide consistency to every staff member • Provides consistency in when and where to report clinical risk and incidents • Individualises care via the variance tracking

10. Pathway solutions Business Improvement: • Collection of the right clinical outcome and variance evidence (through RDNS Mobility solutions and reporting) as a platform for Continuous Improvement  • Reduction in unnecessary documentation • Pathways proven by clinical evidence with predictable costs demonstrating value for money to our funders (reducing overall burden on health system) • We have a better record of care to follow up if a client complains

11. RDNS: Checklist for development • Identify need • Obtain commitment from clinicians • Form group with relevant stakeholders • Pathway • Establish aims and outcomes for evaluation • Evidence • Draft pathway • Review draft • Costings • Education to staff • Trial pathway • Evaluate results and act/adjust accordingly • Implementation • Establish ongoing review process

12. RDNS: Current Pathways • VLU • Urinary Catheter Management • EOL • Diabetes Self-Management • Medication Streaming

13. RDNS: Pathways in development • Urinary assessment & management • Bowel assessment & management • Insulin Management • Palliative Symptom Management • COPD • Asthma • Stage 3/4 Pressure Ulcer

14. Translating Evidence into Practice or Pitfalls & Perils or Critical steps and challenges • Staff engagement – how do we achieve this • Uptake – why use this when a care plan is easier • Registration of the clinical care indicator • Variance tracking – how to improve uptake & registration for audit & evaluation • Changing the culture (too busy, too hard etc.) • Evaluation – how and when • Platforms for monitoring clinical indicator information – the value of this information to inform future services • Audit processes • Changes to client health status – how do we measure

15. Evaluation of pathways Identified through clinical indicators developed from: • Client/staff uptake of pathways (client care indicator is registered when the pathway is commenced) • LOS data • Healing rates • Health outcomes achieved • Discharge rates • Meeting or improving on benchmark standards

16. Summary • Brief overview of the importance of developing and implementing care pathways to improve care delivery and health outcomes and support a new model of care. • Piloting the pathway is as important as the development • Evaluation is the final step in ensuring success • Ongoing pathway uptake and monitoring of variances relevant to individual Clinical Specialties • Committing to business as usual